August 2020, Volume XXXIV, Number 5

  CAPSULES

MDH issues guidance on long-term care visits

New guidance from the Minnesota Department of Health (MDH) intended to balance COVID-19 safety and visitation restrictions with the well-being of residents in long-term care facilities is now in effect.

Since March, visitor restrictions have been in place in long-term care settings to prevent the spread of the disease. However, balancing these restrictions with the well-being of residents is an urgent priority to limit unintended harms of social isolation. The new guidance states that the primary consideration for facility visitation decisions should be whether there has been an exposure in the facility from a COVID-19 case in a resident, staff, or visiting service provider within the past 28 days.

It also provides a series of factors facility management can use to evaluate their COVID-19 risk, and details a process for opening up to a greater level of visitation when it is deemed appropriate to do so.

Risk factors for facility management also include case incidence in the surrounding community, facility size, and the extent to which staff at the facility are working at other LTC facilities. The guidance states that facilities should develop testing plans with baseline facility-wide testing within a window of time before or after opening, depending on facility type. Facilities should refer to existing MDH guidance on the appropriate use of testing in long-term care facilities. A key factor that determines the testing needed is whether the facility is a nursing or assisted living-type facility. Nursing home residents are considered to be at a higher risk of contracting and dying from COVID-19, which is why they must conduct facility-wide testing. Assisted living type-facility residents are still at high risk, and so facility-wide testing is recommended.

Medicare to implement simplified coding and documentation guidelines

Major modifications are coming to the coding, documentation, and payment of evaluation and management (E/M) services for office visits as Medicare has signaled its intention to implement finalized guidelines and payment rates on Jan. 1, 2021.

“The AMA appreciates that CMS will implement significant increases to the payment for office visits, based on recommendations on resource costs from the AMA/Specialty Society RVS Update Committee (RUC),” said American Medical Association President Susan R. Bailey, MD. “Unfortunately, these office visit payment increases, and a multitude of other new CMS proposed payment increases, are required by statute to be offset by payment reductions to other services, through an unsustainable reduction of nearly 11% to the Medicare conversion factor. For this reason, the AMA strongly urges Congress to waive Medicare’s budget neutrality requirement for the office visit and other payment increases. Physicians are already experiencing substantial economic hardships due to COVID-19, so these pay cuts could not come at a worse time.”

Bailey said that reducing documentation overload and providing physicians more time with patients was the fundamental purpose of overhauling the E/M office visit guidelines.

Key elements of the E/M office visit overhaul include:

  • Eliminating history and physical exam as elements for code selection. While significant to both visit time and medical decision-making, these elements alone should not determine a visit’s code level.
  • Allowing physicians to choose whether their documentation is based on medical decision-making (MDM) or total time. This will recognize the work involved in non-face-to-face services like care coordination.
  • Modifying MDM criteria to move away from simply adding up tasks to focus on tasks that affect the management of a patient’s condition.

While CMS recognized the increases in the payment bundles for maternity care and a few other select services, the visits within the surgical global payment bundle remains unchanged. The AMA strongly supports CMS adoption of the office visit changes and continues to urge CMS to incorporate the office visit payment increases into the global surgery packages.

New mental health hold provisions now in effect

During the first special session of the Minnesota Legislature, lawmakers passed a comprehensive health and human services policy bill that included provisions impacting the implementation of several state human service programs. Included in that bill, now Chapter 2 of special session law, were revisions to Minnesota’s civil commitment statutes—a longtime priority of mental health advocates including NAMI Minnesota—including the laws related to mental health transport holds and emergency holds (often referred to as “72-hour holds”). This language can be found in Section 33, Subdivisions 2 and 3.

Under the new Minnesota law, statutory language related to transport holds and emergency holds was revised to increase clarity, revise definitions, and bring the law in line with the current mental health system.

Revisions included expanding the scope of health care professionals who could order a transport or emergency hold, clarifying that a transport hold issued by a health care professional is sufficient authority for law enforcement to transport a person with a mental illness, and expanding the authority of health care facilities to provisionally discharge patients on an emergency hold (an authority that was previously limited to the commissioner of human services).

The new law also limits the duration of a transport hold to 12 hours, while the prior law included no time frame.

University opens clinical trial for new treatment of COVID-19

A patient with COVID-19 and lung failure at the University of Minnesota is the first to be treated in the U.S. under a new FDA-approved clinical trial to determine the safety and effectiveness of mesenchymal stem cells (MSCs). This new treatment—for some of the sickest COVID-19 patients—is aimed at halting the intense inflammatory response of the body, referred to as a “cytokine storm.” The cytokine storm is caused by the body’s immune response to the coronavirus. If unchecked, it can cause extensive organ damage, most often lung failure.

The study is led by David Ingbar, MD, a critical care and pulmonary physician at the M Health Fairview University of Minnesota Medical Center (UMMC) and director of the University of Minnesota Medical School’s Division of Pulmonary, Allergy, Critical Care and Sleep Medicine. He also served as the President of the American Thoracic Society, the largest U.S. critical care and pulmonary organization.

The study, led and developed by the team of researchers at the University of Minnesota, will include other academic centers across the U.S. The multisite study is open now at M Health Fairview UMMC and Bethesda Hospital, which was previously converted into the state’s first dedicated COVID-19 care facility.

To determine the benefit of MSCs, patients will be randomized to receive three doses of MSC 48 hours apart or a placebo solution.

New cases of severe lung injuries associated with vaping suspected

The Minnesota Department of Health (MDH) recently sent an alert to health care providers in response to reports of 11 suspected cases in Minnesota of severe lung injuries associated with vaping.

The vaping cases in Minnesotans ages 14- to 46-years-old occurred in June and July, with a median age of 18 years. Diagnosis was made more difficult because the symptoms of the disease can be similar to those of COVID-19. All 11 cases resulted in hospitalizations with some requiring intensive care, including being placed on ventilators.

“We want providers and the public to be aware of the continued dangers of vaping products, and the possibility of lung injuries presenting as COVID-19,” said Minnesota Commissioner of Health Jan Malcolm. “As we continue to investigate the causes of the lung injuries, we encourage people to take advantage of our free Quit Partner resources to help with quitting vaping.”

The patients sought care for symptoms similar to severe COVID-19 infection, including cough and shortness of breath. However, testing found the patients were not infected. Patients also responded to systemic steroid therapy, the treatment for e-cigarette or vaping product use-associated lung injury (EVALI).

The patients said they had a history of vaping. Most reported vaping THC or tetrahydrocannabinol, the principal and most active ingredient in marijuana. Some reported using nicotine-based products.

There are similar reports of a resurgence of lung injury cases in California.

Davis welcomes new health care tenants

Davis has announced new tenants at its CityPlace II and CityPlace III facilities.

CityPlace II  is a 42,000-square-foot Class A multi-tenant medical building designed by Synergy Architecture Studio. The entire first floor is home to Shriners Children’s, a nonprofit organization that provides specialized pediatric orthopaedic services. Their new space features what Shriner’s describes as “high-tech” and “high-touch” technology to benefit their patients.

Adrefis & Toppin Women’s Specialists have also moved their clinic into CityPlace II. They are a full-range obstetrics and gynecology practice with more than 20 years of experience. They offer holistic, individualized treatment from a team of all-female physicians.

CityPlace III, a 15,000-square-foot single-tenant building, is home to Midwest ENT. Midwest ENT offers multiple ear, nose, and throat services, including hearing aid systems, allergy and asthma treatment, and facial plastic surgery and aesthetic skin care.

CityPlace is home to more than 200 health care-related businesses in Woodbury. 

 

  Medicus

Kris Ann Schultz, MD, a pediatric oncologist and hematologist with Children’s Minnesota, has been named inaugural holder of the Pine Tree Apple Tennis Classic Endowed Chair in Cancer and Blood Disorders Research in recognition of her clinical and academic accomplishments in the field of childhood cancer research, as well as her roles as principal investigator for two registries at Children’s and a grant funded by the National Cancer Institute/National Institutes of Health.

 

Two physicians—who happen to be married to each other—have joined CentraCare. Olivia Lee, MD, MBA, will practice in CentraCare’s Urology Clinic, where she will specialize in endoscopic, laparoscopic, robotic, and open surgeries. Previously a physician with Kaiser Permanente in California, her special clinical interests are management of kidney, prostate and bladder cancers, kidney stones, BPH, prosthetics, and urinary incontinence. Dr. Lee’s spouse, Gilbert Cadena, MD, will serve as a neurosurgeon in the Neurosciences Brain & Spine Center. A member of the Congress of Neurological Surgeons, the American Association of Neurological Surgeons, and the North American Skull Base Society, Dr. Cadena’s special clinical interests include brain tumors, skull base tumors, brain aneurysms, carotid occlusive disease, and neuroendoscopy.

 

Patrick Hughes, MD, has joined St. Luke’s Emergency Department. Dr. Hughes received his medical degree from the Medical College of Wisconsin in Milwaukee. He then completed his residency and an emergency cardiology fellowship at Beth Israel Deaconess Medical Center in Boston, Massachusetts. Prior to joining St. Luke’s, Dr. Hughes was an attending physician at Beth Israel Deaconess Medical Center.

 

Denisse Broadbent, MD, who specializes in pediatrics, has joined the Essentia Health St. Joseph’s–Baxter Clinic. Originally from Guayaquil, Ecuador, Dr. Broadbent earned her medical degree at the Universidad Catolica Santiago De Guayaquil in Ecuador. She completed her residency in pediatrics at El Paso Children’s Hospital at Texas Tech University Health Sciences Center in El Paso, Texas. A native Spanish speaker, she welcomes bilingual patients. 

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CityPlace is home to more than 200 health care-related businesses in Woodbury. 

Denisse Broadbent, MD, who specializes in pediatrics, has joined the Essentia Health St. Joseph’s–Baxter Clinic. Originally from Guayaquil, Ecuador, Dr. Broadbent earned her medical degree at the Universidad Catolica Santiago De Guayaquil in Ecuador. She completed her residency in pediatrics at El Paso Children’s Hospital at Texas Tech University Health Sciences Center in El Paso, Texas. A native Spanish speaker, she welcomes bilingual patients.